What is MS?

Well, it is now widely accepted that MS is an autoimmune disorder which means that one's own immune system attacks the myelin in the cells in the Central Nervous System(CNS) but this raises a number of interesting questions.

Why? What starts the process? Why are some countries devastated by the condition while the population of others remains largely unaffected? And why are the incidents of the condition generally spread, even within the same country, dependent on distance from the equator - a latitude gradient, in other words.

Ashton Embry argues convincingly in his series of essays on the subject, and in his Online Presentations, and in his MS Booklets, that diet, in conjunction with low levels of natural sunshine (vitamin D3), is the main cause of the condition in genetically susceptible individuals.

It is estimated that around 0.5% of northern Europeans carry the gene that makes them susceptible to the condition and they, and their descendants, are most at risk. As a result, the USA, Canada, NZ and Australia are all high incidence areas.

In the first of his essays, Multiple Sclerosis and Food Hypersensitivities, he sets out to identify the most likely cause of the condition and, in the process, establishes 9 constraints that the answer, whatever it proves to be, must satisfy. Only diet satisfied all nine constraints and can, therefore, be considered the most likely cause.

In his essay The Best Bet Treatment, he goes on to discuss the most likely disease process involved and to establish the therapy that will give the greatest chance of success which has become known as The Best Bet Diet.

It should be remembered, however, that this essay was written some time ago and, in this field, the latest research can change quite quickly. As a result, the suggested list of supplements shown in this essay is now out of date but the list shown in the BBD Supplements page will always be accurate.

N.B. An excellent example of how the latest research can change already well-researched findings is in the case of vitamin D3. Ashton readily admits that, had the latest findings on vitamin D3 been available some years ago, these two essays would have been somewhat different. Vitamin D3 is the missing piece of the puzzle. The lynchpin that holds the whole argument together and, as such, it takes pride of place in the next section.

Distribution of MS

As mentioned previously, there is a distinct latitude gradient associated with the spread of the condition throughout the world and this is, of course, most noticable in countries with large geographical areas like Australia. Canada and the USA. In the northern hemisphere countries (Canada and the USA) the high incidence areas are in the North which is furthest from the equator and, therefore, the areas with the least sunshine. In Australia, the opposite is true. The sunnier northern areas have a much lower incidence rate per head of population than the southern states and in both cases the incidence rate graduates with latitude.

So, the possible link between MS and lack of sunshine is clearly established but this is not the whole story. There are areas in the world where the level of sunshine is comparatively low and yet the rate of MS is also low but these are invariably communities whose diet is based primarily on fish.

Now, is this simply a coincidence or is there a possible link between these two phenomenon? Well, yes there is, vitamin D3(Cholecalciferol). The two main sources of Vitamin D just happen to be sunshine and oily fish. So, could it be that vitamin D affords some level of protection against the condition for those fortunate enough to live in sunnier climates or who have a diet based primarily on oily fish and, if so, what mechanism is at work in the MS disease process?

Ashton answers both these questions in his paper  Vitamin D Supplementation in the Fight Against MS and another interesting paper outlines how a study on British and Irish migrants to Australia found that the risk of developing MS was reduced by up to 75% dependant on the latitude of where the migrants settled. In other words, the further north they settled, the more sunshine, the more vitamin D3 and the less risk of MS.

Colleen Hayes Ph.D, from the University of Wisconsin, adds weight to the argument in favour of vitamin d3 as part of an effective therapy in the treatment of MS. In her paper Vitamin D: A Natural Inhibitor of MS, she suggests that MS may actually be preventable. Whilst not generally considered a genetically inherited condition, the children of an individual with MS do, apparently, have a 20 to 40 fold increased risk of developing the condition compared to unrelated individuals.

However, she also states "..the evidence that vitamin D might be a natural inhibitor of MS is compelling," and, as a consequence, suggests "..it would be reasonable to provide supplemental vitamin d to individuals who are at risk of developing the condition."

A most important consideration is the situation during pregnancy. Quite simply, there is a well established reduction in MS attacks during pregnancy and an increased occurence following childbirth. Ashton quotes the plausible hypothesis of Swartz(1993) that this was due to the large increases in the production of the vitamin d hormone during pregnancy and its rapid decline after childbirth.

So, how much vitamin d is required to prevent MS developing? How much is safe? How does one go about it? These questions are all answered later but, for now, we need to return to the discussion on the implications that diet can have for the development of the condition.

MS Disease Process

First, we need to examine the basic disease process of MS and it is believed that the most likely scenario is this.

• The autoimmunity process is ignited by intact (undigested) food proteins escaping through the gut walls, a process known as Leaky Gut Syndrome, and into the circulatory system where the immune system response is to attack the invaders.
• The molecular structure of parts of the proteins in certain foods is so similar to parts of the proteins in myelin that the immune system cannot differentiate between invaders and self (known as Molecular Mimicry) and ends up also attacking the myelin, in the cells in the CNS.
• For this attack to take place, however, it must do so across a compromised Blood Brain Barrier that, under normal circumstances, would have prevented this attack from taking place.

So, it would appear that the individual with MS is someone whose food is not properly digested, possibly due to low stomach acid contents, and who, as a result, may have had a history of stomach problems prior to the diagnosis of MS. The gut wall, which in parts is only one cell thick, has become porous and is allowing these undigested food proteins to leak into the blood system where their immune system automatically creates antibodies to attack the invaders. The individual is also someone whose blood brain barrier has been compromised, for whatever reason, and the myelin in the cells in the Central Nervous System is open to attack.

The Best Bet Diet

Basically, Ashton Embry's Best Bet Diet(BBD) works on two fronts.

1 - To stop, or at least restrict, the consumption of foods whose molecular structure is so similar to the myelin in our own bodies that they could ignite the autoimmunity process and cause an attack on the myelin in the CNS. These "suspect" foods are as follows;

• Dairy - Avoid all animal milks, and all butters, cheeses, and yoghurts made from them, and all products that contain them. Where appropriate, replace in the diet with rice milk or low fat coconut milk, both of which are widely available on the supermarket shelves, these days.
• Gluten - Avoid all wheat, rye and barley, and all products containing them. It is advised that oats are also avoided despite new research suggesting they contain no gluten. For our purposes, they are still regarded as a "modern" grain, added to the diet only in recent times, and the chances of avoiding autoimmune reactions is greater without them. These "suspect" grains are replaced in the diet with rice, corn, quinoa and a whole range of other grains/flours that are both gluten-free and widely available these days.
• Legumes - Avoid all beans, peas and pulses, especially soya, and all products containing them. All other vegetables are allowed, in particular the green leafy ones, like spinach and brocolli that are high in omega 3 EFA.
• Refined sugar is also avoided, wherever possible, because it can make the leaky gut worse and can also adversely affect the immune system. More acceptable alternative sweetners are honey, maple syrup, fruit sugar(fructose) and stevia.
• Eggs and Yeast are both allowed in limited quantities as long as the individual shows no specific allergic reaction to them.

Please note: As an additional precaution, it is suggested that the individual also has a ELISA blood test done to identify which, if any, foods have escaped across the leaky gut in the past. The argument goes that the individual's immune system will have created an lgG antibody, as part of its defence mechanism, the presence of which can be detected during the test, when presented with a sample of the same food. The assumption being that the individual may be hypersensitive to these foods and they may be contributing to the pourous nature of the gut. It would seem sensible, as part of the overall strategy, to either avoid or reduce the intake of these foods in the diet, at least for a time, to give the leaky gut a chance to heal.

In general, those following this approach enjoy a diet based primarily on the breast of chicken or turkey, fish, game meats and beef from cattle that have been fed exclusively on grass. The diet is also low in saturated fat and aims to achieve a far healthier balance of omega 6 - omega 3 fats than is normal in today's western society, where the condition is now rife. More detailed information is shown in the Getting Started Guide.

2 - To take a range of supplements that can have a positive effect on each aspect of the disease process. In other words,

• To reduce the risk of autoimmune reactions by "dampening down" the immune system. These include vitamin d3(cholecalciferol), calcium, magnesium, omega 3 fish oil and vitamin E.
• To help repair the leaky gut and prevent the escape of intact food proteins into the bloodstream in the first place. These include acidophilus, grape seed extract, fish oil and enzymes.
• To strengthen and heal the blood brain barrier to prevent attacks on the myelin in the Central Nervous System. These include gingko biloba, grape seed extract, pycnogenol and co-enzyme QIO.

Vitamin D Supplementation

Now, to return to the specific questions relating to vitamin d supplementation. Damien Downing argues, in his paper Vitamin D - A Time For Reassessment, that the current Recommended Daily Allowance(RDA), for vitamin D is woefully inadequate and based more on 19th century folklore than on any real science. Rheinhold Veith examines the safety issue in his paper Efficiacy and Safety of Vitamin D. He suggests that for individuals who spend little or no time in the sun an intake of 4000iu per day is not only perfectly safe but also necessary to raise 25(OH)D levels to the optimum range.

Now, those convinced by the evidence should be aware that the most reliable indicator of circulating vitamin D levels is the 25(OH)D test and regular testing of this, both before and during supplementation, is essential.

The key is to ensure a level of circulating vitamin D - 25(OH)D - of between 100 and 125nmol/l which is considered to be the optimum range to maintain good health and to reduce the risk of autoimmune reactions developing into full-blown autoimmune disease.

The advised procedure is this.

1. Arrange for a 25(OH)D blood test at your doctors before beginning supplementation. You will need to obtain your GP's continued support for this and, in the circumstances, it would seem advisable to take copies of the vitamin D essays with you to explain what you intend to do. Papers IPS-03, IPS-04, and IPS-05, certainly, and perhaps even IPS-10, and IPS-11. It would make sense to send these papers down to the surgery in advance of your appointment to allow your GP time to study them. Of course, as more and more PWMS learn about the potential benefits of supplementation with vitamin D, you may find you're not the first in your GP's practice to request the test and they may already know about it.
2. In the UK, this test should be available free of charge from your GP although some group members have had to pay a nominal fee in the past so don't be surprised if this is the case.
3. Make sure they order the correct test. It is the 25(OH)D test and NOT the 1,25(OH)D test.
4. Be warned, it can take several weeks to obtain the results and, as mentioned previously, you should also have your serum calcium levels checked at the same time and these should remain in the range 2.2-2.6 nmols/L, at all times, to ensure hypercalcemia does not develop.
5. When the results are back, make sure they give you the actual figure. You will need this to compare with future readings. The so-called "normal" range is anything between 30 and 120nmol/L but we are aiming for the optimum level, at the very top of this range, between 100nmol/L and 125nmol/L.
6. We would appreciate if you could let us know the figures for our study each time you have the test done. Just call the MSRC freephone number and give the staff details of your 25(OH)D reading, your serum calcium level, how long you have been supplementing with vit d and how much vit d you take each day. They may also ask you questions relating to your age, general exposure to sun and the area of the country in which you live and work but details are still being finalised.
7. If you have children and intend to use vitamin D as a protection against them developing the condition, it is important to discuss this with your doctor as well and have their levels of 25(OH)D and serum calcium checked BEFORE starting the process.
8. It is essential that, while supplementing with vitamin D3(cholecalciferol, you also supplement with 1200mg essential calcium and 600-1200mg magnesium, to prevent osteoporosis.
9. Once again, we would ask that you let us know the figures for our study.

The table below, and the following introduction, have been produced by Ashton Embry himself to ensure that those who are supplementing with vitamin d, do so in full knowledge of the aims, objectives and possible safety issues involved.

      "The key to vitamin D supplementation is to have one's 25D level between 100 and 125 nmol/l all year and to not exceed 150 nmol/l for too long.

     The trick is that there is no single supplement dosage which will achieve this. For some, 4000 IU all year will be fine. For others such a dosage will result in a very high and possibly problematic 25D level. For others such a dose may not be enough to achieve the optimal 25D level.

     I think 100-125nmol/L is the safest 25D level bracket given the data we currently have which is not very constraining. Vieth would claim that anything under 225 is safe but there are few hard data to support this. However data, which say that levels between 150 and 200 are a problem, are also very scarce.

     Krispin would say stay below 150 or perhaps even 125. This is playing it safe which I endorse. As Krispin emphasizes, the key is 6 month testing (once in October and once in April) in the first few years to determine what level of supplementation one needs in both the Oct-April and the May-Sept time periods to achieve a 25D level which stays year around in the 100-125 bracket.

    The table below should reflect these strategies. It's important to get this right." Ashton Embry

Vitamin D Supplementation Table

Northern Hemisphere Countries (including UK)

Test every October and April for first 2-3 years.

25(OH)D (nmol/L)	25(OH)D ng/ml, mcg/L,pcg/mcl	Vit D Supps(IU)
> 75 in Apr or Oct	>30 in Apr or Oct	4000 all year round
75 - 100 in Oct	30-40 in Oct	4000 Oct - Apr
75 - 100 in Apr	30-40 in Apr	2000 Apr - Oct
100 - 125 in Oct	40-50 in Oct	2000 Oct - Apr
100 - 125 in Apr	40-50 in Apr	400 Apr - Oct
125 - 150 in Oct	50-60 in Oct	1000 Oct - Apr
125 - 150 in Apr	50-60 in Apr	None Apr - Oct

Please note -To convert between nmols/L and ng/ml, simply multiply by 2.5. Also, ng/ml(nanogramms per millilitre), mcg/L(microgramms per litre) and pcg/mcl(picogramms per microlitre) are all the same and, as such, the same conversion factor of 2.5 still applies.  

For more information on how to get started on The Best Bet Diet, we would advise you to download the BBD Recipe book from Ashton Embry's DIRECT-MS site. It is available in both pdf and doc formats. Click here.